Trephination and silicone tube intubation in the treatment of canalicular obstruction.

PURPOSE: To evaluate the efficacy of trephination and monocanalicular/bicanalicular silicone tube use depending on the number of affected canaliculi in patients with canalicular obstruction. METHODS: This retrospective study included 46 eyes of 36 patients who underwent trephination and silicone tube intubation performed by a single experienced oculoplastic surgeon due to canalicular obstruction between 2005 and 2020. Monocanalicular silicone tube was applied to patients with one canalicular obstruction, and bicanalicular silicone tube was applied to those with the upper and lower canalicular involvement of the same eye. Canalicular obstructions were divided into groups according to their localization as proximal, middle, and distal. The silicone tubes were kept in place for at least 5 months after the operation, and the follow-up duration of the patients was at least 12 months. RESULTS: Twenty (55.6%) patients were female and 16 (44.4%) were male. The mean age was 15.82 ± 7.02 years in the treatment success group and 28.87 ± 12.74 years in the treatment failure group (p = 0.001). While 67.6% of the eyes in the treatment success group had monocanalicular obstruction (monocanalicular silicone tube applied), 66.7% of those in the treatment failure group had bicanalicular obstruction (bicanalicular silicone tube applied) (p = 0.049). The most common distal obstruction was seen in the treatment success group, and the least distal obstruction and the most proximal obstruction were observed in the treatment failure group (p < 0.001). The mean duration silicone tube stay was 9.37 ± 1.96 months in the treatment success group and 7.25 ± 1.42 months in the treatment failure group (p = 0.003). CONCLUSION: We consider that trephination with the use of a monocanalicular or bicanalicular silicone tube depending on the number of affected canaliculi can be the first choice of treatment in canalicular obstruction due to its high success rate, especially in distal obstruction.

The significance of primary monocanalicular silicone tube intubation in late surgical treatment in children.

PURPOSE: To evaluate the effect of monocanalicular silicone tube intubation outcomes as an initial surgical treatment in children older than 1 year old with primary nasolacrimal obstruction. METHODS: Probing or monocanalicular silicone tube intubation was performed as primary surgical treatment on 12-48 months old children with primary nasolacrimal obstruction. Probing was performed on 53 eyes of 43 patients and silicone tube intubation on 45 eyes of 39 patients. Treatment was considered successful after improvement in patient complaints, the presence of normal tear meniscus, and normal results of fluorescein disappearance time test. Retrospective treatment success was compared between two groups according to age groups. RESULTS: Treatment success was 79.1% in the probing group and 92.3% in the silicone tube intubation group. The success of the treatment was evaluated separately in the groups of 12 to <24 months, 24 to <36 months, and 36 to <48 months, and although the success level of the silicone tube intubation group was consistently found to be higher, the difference was not statistically significant. Treatment success decreased statistically significantly in the probing group with increased age of the patients, especially after 24 months. There was no such statistically significant decrease in the silicone tube intubation group. CONCLUSION: The choice of monocanalicular silicone tube intubation for primary surgical treatment in children with primary nasolacrimal obstruction provides success without the need for repetitive surgical interventions, especially in children older than 24 months.

Clinical Performance of Samfilcon A Contact Lenses in Intensive Digital Device Users: A Multicenter, Prospective Clinical Study.

INTRODUCTION: To evaluate patient satisfaction with samfilcon A contact lenses (CLs) in intensive digital device users with myopia and to compare patient satisfaction with samfilcon A lenses to prior experience with senofilcon A or lotrafilcon B CLs. METHODS: This was a comparative, prospective, national study conducted at 14 centers in Turkey. Subjects were adults aged 18 and 45 years with myopia (range -0.25 D to -6.00 D) who spend a minimum of 3 hours viewing digital devices (e.g., computer, smartphone). A subgroup of patients were habitual lens wearers (senofilcon A or lotrafilcon B lens wear for at least 6 months prior to enrollment). The primary assessment was patient satisfaction with samfilcon A lenses (0-100 Likert scale). Secondary assessments included patient satisfaction with samfilcon A lenses compared to patients' habitual lenses, investigator satisfaction with samfilcon A lenses and investigator-evaluated slit lamp examination findings. RESULTS: Samfilcon A lenses were given high overall ratings from both patients and investigators, with a low incidence of ocular symptoms. Overall, patients were highly satisfied with samfilcon A lenses for comfort, vision and overall performance, and stated that they would consider wearing these lenses in the future. Among habitual senofilcon A or lotrafilcon B lens wearers, samfilcon A lenses were rated significantly better than the habitual lenses in regard to comfort, vision and overall performance. Investigator assessments were also highly favorable, both at initial fit and after 4 weeks of follow-up, with no significant findings noted on slit lamp examination. CONCLUSION: Samfilcon A lenses were rated highly by investigators in regard to fit, handling and slit lamp findings, and by novice and habitual lens wearers in regard to comfort, vision and overall performance. These results support the use of samfilcon A lenses among digital device users who seek day-long comfort and good visual acuity.

Comparison of the Effects of Dovitinib and Bevacizumab on Reducing Neovascularization in an Experimental Rat Corneal Neovascularization Model.

PURPOSE: To compare the inhibitory effects of dovitinib and bevacizumab for treatment of corneal neovascularization (CNV). METHODS: Thirty-nine adult female Sprague Dawley rats weighing 180 to 250 g were used. CNV was induced by silver nitrate in the right eye of each rat. After the chemical burn, the animals were randomized into 5 groups. Group 1 did not receive any chemical substance. Group 2 received dimethyl sulfoxide, group 3 received bevacizumab 5 mg/mL, group 4 received dovitinib 5 mg/mL, and group 5 received bevacizumab 5 mg/mL + dovitinib 5 mg/mL topically administered twice daily for 14 days. On the 14th day, slit-lamp examination was performed, and anterior segment photographs were taken. The corneal neovascular area was measured on photographs as the percentage of the cornea's total area using computer imaging analysis. The corneal sections were stained with hematoxylin and eosin for histopathological examination. RESULTS: A statistically significant decrease in the percentage of CNV was found in all treatment groups (group 3, group 4, and group 5) compared with the control group (group 1) (P < 0.01). A statistically significant difference in the percentage of CNV was found among group 3, group 4, and group 5 (P = 0.003). The percentage of CNV in group 4 was significantly higher than that in group 3 and group 5 (P1 = 0.004; P2 = 0.006). There was no statistically significant difference in the percentage of CNV between group 3 and group 5 (P = 0.228). CONCLUSIONS: Dovitinib is a newly developed multitargeted tyrosine kinase inhibitor. Topical administration of dovitinib effectively inhibited CNV, but this effect of dovitinib was found less than topical bevacizumab.

Evaluation of Corneal Biomechanical Changes After Collagen Crosslinking in Patients with Progressive Keratoconus by Ocular Response Analyzer.

OBJECTIVES: To evaluate corneal biomechanics before and after collagen crosslinking (CXL) in patients with progressive keratoconus. MATERIALS AND METHODS: In this prospective study, CXL was performed under topical anesthesia after removal of the epithelium (epi-off technique) by applying ultraviolet A (UVA) light at a wavelength of 365 nm and power of 3 mW/cm2 or 5.4 joule/cm2. Isoosmolar 0.1% riboflavin solution was administered before and during UVA irradiation. In addition to ophthalmologic examination, ocular response analyzer measurements were performed pre- and postoperatively. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated intraocular pressure (IOPcc), Goldmann-correlated intraocular pressure (IOPg), and central corneal thickness (CCT) were recorded. RESULTS: The study included 35 eyes of 30 patients with progressive keratoconus. The mean age was 28.2±6.5 years and postoperative follow-up time was 20.2±14.7 months (range: 6-74 months). The mean CH was 8.60±1.23 mmHg preoperatively, 8.96±2.05 mmHg in the early postoperative period (1-6 months), (p=0.28) and 8.96±1.28 mmHg in the late postoperative period (10-29 months) (p=0.48). Mean CRF was 7.13±1.50 mmHg preoperatively, 8.48±2.16 mmHg in the early postoperative period (p=0.009), and 7.71±1.29 mmHg in the late postoperative period (p=0.40). Mean IOPcc was 12.78±2.34 mmHg preoperatively, 15.38±4.21 mmHg in the early postoperative period (p=0.12) and 13.68±3.61 mmHg in the late postoperative period (p=0.48). Mean IOPg was 9.56±2.73 mmHg preoperatively, 13.01±4.45 mmHg in the early postoperative period (p=0.046), and 10.86±3.47 mmHg in the late postoperative period (p=0.44). Mean CCT was 484.43±41.26 µm preoperatively, 474.16±64.74 µm in the early postoperative period (p=0.70), and 470.38±33.64 µm in late postoperative period (p=0.71). CONCLUSION: CXL is a treatment modality believed to affect corneal biomechanics in keratoconus, but the results of larger patient series with longer follow-up periods may enable a better evaluation.

Comparison of the neuroprotective effects of brimonidine tartrate and melatonin on retinal ganglion cells.

PURPOSE: We aimed to compare the neuroprotective effects of brimonidine tartrate (BRT) and melatonin (MEL) on retinal ganglion cells (RGCs) in a rat glaucoma model. METHODS: Thirty-six adult Wistar albino rats were allocated into six groups: control (C), glaucoma (G), BRT, MEL, G + BRT and G + MEL. After establishing the glaucoma model, intraocular pressure (IOP) of all animals measured at day 4 and day 30 was compared statistically with day 0 and day 4, respectively. Prior to sacrification at day 30 for histological evaluation and TUNEL analysis, retrograde labeling of non-apoptotic RGCs with 3% Fluorogold was performed and RGCs were evaluated under fluorescein microscope. RESULTS: IOP measurements at day 4 were significantly higher than basal measurements in all glaucoma groups. BRT alone induced a time-dependent decrease in IOP (p < 0.05), while MEL alone failed to reduce IOP. However, both BRT and MEL reduced IOP in the presence of glaucoma at day 30 (p < 0.05). BRT treatment significantly reversed the reduced non-apoptotic RGC counts (p < 0.01) and increased TUNEL-positive RGCs (p < 0.001) to control group levels in the presence of glaucoma. However, no statistical significance was found between groups G and G + MEL considering 3% Fluorogold-labeled cell counts and apoptotic index values. CONCLUSION: Our study revealed that systemic administration of BRT also has an IOP reducing effect. MEL has no neuroprotective effect on RGCs; on the other hand, BRT acts as a neuroprotective agent against glaucomatous injury, when applied systemically.

The Importance of Frozen Section-Controlled Excision in Recurrent Basal Cell Carcinoma of the Eyelids.

OBJECTIVES: To show the importance of frozen section-controlled excision to avoid the re-recurrence of recurrent basal cell carcinoma (BCC) of the eyelids. MATERIALS AND METHODS: Thirty-five cases who underwent eyelid tumor excision in different centers and were admitted to our clinic with recurrent eyelid tumors. Recurrent tumors were resected by excision 1-2 mm from the tumor's visible margin and sent to pathology for frozen section examination. Eyelid reconstructions with flap and graft were performed after confirming that the surgical margins were negative. RESULTS: Twenty-one (60%) of our patients were male and 14 (40%) were female. Median age of our group was 63.4±14.2 years. Excision and sending the excised material for frozen section control was performed once for 11 patients, twice for 12 patients, 3 times for 8 patients and 4 times for 4 patients to confirm that the surgical margins were clean. All pathology samples were reported as BCC. All patients had eyelid reconstruction with flap and graft. Recurrence was detected in 2 patients (5.7%) during 1 to 8 years (mean 4.3 years) of follow-up and those patients were reoperated; no recurrence was detected in the remaining 33 patients (94.3%). CONCLUSION: Frozen section control can provide low re-recurrence rate in patients with recurrent BCC of the eyelids.

Orbital Eccrine Hidrocystoma.

A 29-year-old female patient presented with a painless mass on her upper eyelid medially. She noticed the mass 4 years earlier and it had increased in size over time. She had no diplopia, eyelid swelling, skin lesion overlying the mass, or visual disturbances. On ocular examination, eye movements and funduscopy were normal. The mass was movable and painless with palpation. Magnetic resonance imaging with contrast showed a 12x8x7 mm well-circumscribed cystic lesion with no contrast dye appearance. Surgical removal was performed delicately and no capsular rupture occured. Pathological examination revealed an eccrine hidrocystoma. Our aim is to underline that eccrine hidrocystoma should be included in differential diagnosis of orbital masses.

Macular Thickness in Highly Myopic Children Aged 3 to 7 Years.

PURPOSE: To compare the macular thickness and volume of highly myopic children with healthy controls, using third generation optical coherence tomography (OCT). METHODS: OCT was performed on highly myopic (cycloplegic spherical equivalent refraction > -6.00 diopters [D]) children aged 3 to 7 years old and healthy controls (spherical equivalent refraction -2.00 to +4.00 D) between 2011 and 2013. OCT measurements of the average thicknesses of the fovea (central 1 mm) and inner (1 to 3 mm) and outer (3 to 6 mm) parafovea in superior, temporal, inferior, and nasal quadrants and total volume of the macular scan area were recorded. The differences between the two groups were tested with the Mann-Whitney U test. RESULTS: There were 15 patients with high myopia and 11 controls. Foveal thickness (central 1 mm) was significantly greater in the high myopia group. The parafoveal thicknesses in all quadrants of the inner and outer circles were significantly thinner in the high myopia group. The average macular volume of the highly myopic eyes was significantly smaller than the control eyes. CONCLUSIONS: Anatomic changes in the retina occur even in young children with high myopia. Macular thickness characteristics of highly myopic children may influence the interpretation of data obtained with OCT.

Fundus Findings in Dengue Fever: A Case Report.

Dengue fever is a flavivirus infection transmitted through infected mosquitoes, and is endemic in Southeast Asia, Central and South America, the Pacific, Africa and the Eastern Mediterranean region. A 41-year-old male patient had visual impairment after travelling to Thailand, which is one of the endemic areas. Cotton wool spots were observed on fundus examination. Fundus fluorescein angiography showed minimal vascular leakage from areas near the cotton wool spots and dot hemorrhages in the macula. Dengue fever should be considered in patients with visual complaints who traveled to endemic areas of dengue fever.

Can the effect of transepithelial corneal collagen cross-linking be improved by increasing the duration of topical riboflavin application? An in vivo confocal microscopy study.

OBJECTIVE: To evaluate the effect of transepithelial corneal collagen cross-linking (CXL) with prolonged riboflavin application by in vivo confocal microscopy and to compare this effect with that of standard CXL with complete epithelial debridement. METHODS: In eyes with progressive keratoconus, CXL procedure was performed with standard technique and transepithelial technique after prolonged riboflavin drop application for 2 hr. Patients were evaluated with in vivo confocal microscopic examination preoperatively and at postoperative months 1 and 6. RESULTS: The depth of CXL effect was similar in both groups (i.e., 380.86 ± 103.23 µm in standard CXL group and 342.2 ± 68.6 µm in transepithelial CXL group) (P=0.4). The endothelial cell counts and morphological parameters (i.e., pleomorphism and polymegathism) were not significantly affected in both groups (P>0.05 for all). In the standard CXL group, in vivo confocal microscopy revealed anterior stromal acellular hyperreflective honeycomb edema with posteriorly gradually decreasing reflectivity and increasing number of keratocytes and some sheets of longitudinally aligned filamentary deposits. The keratocytes were seen to repopulate in the posterior-to-anterior direction. In transepithelial CXL group, although the depth of CXL effect was similar, less pronounced keratocyte damage, extracellular matrix hyperreflectivity, and sheets of filamentary deposits at the posterior stroma was observed. CONCLUSIONS: Transepithelial CXL with prolonged peroperative riboflavin application can achieve similar depth of effect in the stroma with less pronounced confocal microscopic changes as compared with the standard CXL with complete epithelial debridement.

Myopia, visual acuity and strabismus in the long term following treatment of retinopathy of prematurity.

The purpose of this retrospective study is to evaluate the long-term ophthalmological outcome in children with retinopathy of prematurity (ROP) who were treated for threshold disease with indirect laser photocoagulation. 107 eyes of 56 patients with threshold ROP treated with indirect laser photocoagulation and 202 eyes of 101 control patients with spontaneously regressed ROP were included. Fixation pattern, ocular motility findings, visual acuity, anterior segment examination, cycloplegic refraction and indirect ophthalmoscopic dilated fundus examination findings of all the included subjects were recorded. The incidence of unfavorable visual outcome defined as Snellen acuity of < 0.2, esotropia, strabismus surgery, nystagmus, myopia (≥ -0.50 D) and astigmatism (≥ 1.50 D) was significantly higher in the treated group than in the control group. These results indicate that premature babies with threshold ROP treated with indirect laser photocoagulation require frequent and long-term follow-up in order to determine refractive status and the presence of ocular motility disorders over time.

Laser in situ keratomileusis to manage refractive errors after deep anterior lamellar keratoplasty.

PURPOSE: To analyze the visual and refractive outcomes of laser in situ keratomileusis (LASIK) after deep anterior lamellar keratoplasty (DALK) for keratoconus. SETTING: Haydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey. DESIGN: Cohort study. METHODS: Patients with compound myopic astigmatism after DALK and a spherical equivalent (SE) between -2.50 diopters (D) and -8.00 D had LASIK as a single-step procedure, correcting the manifest refraction error. The visual and refractive results at 1 month, 3 months, and the last follow-up were compared with preoperative values. RESULTS: The mean follow-up was 11.17 months ± 3.61 (SD). The mean manifest refraction SE (MRSE) and autorefractometer measurements and the autokeratorefractometer and corneal topography keratometry readings decreased significantly from preoperatively to 1 month postoperatively (P<.01) but did not change significantly thereafter (P>.05). Preoperatively, the mean uncorrected (UDVA) and corrected (CDVA) distance visual acuities were 0.21 ± 0.08 and 0.73 ± 0.08, respectively; postoperatively, the means were 0.73 ± 0.10 and 0.98 ± 0.05, respectively. All eyes achieved a postoperative UDVA better than 0.5. No eye lost CDVA lines. The safety index was 1.34. The mean MRSE was -5.18 ± 1.74 D preoperatively and -1.05 ± 0.64 D postoperatively (P<.01). Postoperatively, 11 eyes (91.67%) were within ± 2.00 D of the SE, 8 (6.67%) were within ± 1.00 D, and 5 (41.67%) were within ± 0.50 D. No complications were encountered. CONCLUSION: Treatment of post-DALK keratoconus patients with LASIK to correct manifest refraction error seems to be a viable option.

Assessment of intrastromal corneal ring segment position with anterior segment optical coherence tomography.

BACKGROUND AND OBJECTIVE: To examine the exact position of implanted Keraring (Mediphacos, Belo Horizonte, Brazil) segments by high-resolution anterior segment optical coherence tomography (AS-OCT). PATIENTS AND METHODS: This study included 17 eyes of 13 patients with keratoconus who underwent uneventful intracorneal ring segment implantation with the aid of femtosecond laser. Eyes were evaluated by AS-OCT at the third postoperative month. Distance from the apex of the triangular cross-section of the ring segment to the anterior corneal surface and distances from two basal corners to the posterior corneal surface were measured. RESULTS: Distance from apex to anterior corneal surface (263.1 ± 42.9 µm) was significantly smaller than target depth calculated intraoperatively (356.9 ± 35.7 µm, P < .001). Distance between outer basal corner and posterior corneal surface was significantly greater than distance between inner basal corner and posterior corneal surface. CONCLUSION: High-resolution AS-OCT is a rapid, convenient, and valuable technique in the follow-up of patients with implanted Keraring segments that may be helpful in predicting ring-related complications.

Endothelial cell loss after phacoemulsification in eyes with previous penetrating keratoplasty, previous deep anterior lamellar keratoplasty, or no previous surgery.

PURPOSE: To compare phacoemulsification-related endothelial cell loss in eyes with previous penetrating keratoplasty (PKP), previous deep anterior lamellar keratoplasty (DALK), or no previous corneal surgery. SETTING: Ophthalmology Clinic, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. DESIGN: Comparative case series. METHODS: Eyes with previous PKP (Group 1), previous DALK (Group 2), or no previous ocular surgery (Group 3) had extracapsular cataract extraction by phacoemulsification. The endothelial cell count was evaluated 1, 3, 6, and 12 months after cataract surgery. RESULTS: Group 1 comprised 16 eyes and Group 2 and Group 3, 20 eyes each. The endothelial cell density (ECD) decreased progressively throughout the follow-up in all groups (P<.01). The amount of change in ECD was significantly greater in Group 1 than in Group 2 and Group 3 from preoperatively to 1 month postoperatively, from 1 to 3 months postoperatively, from 3 to 6 months postoperatively, and from 6 to 12 months postoperatively (all P<.01). The changes were similar in Group 2 and Group 3 at all time points (P>.05). CONCLUSIONS: Eyes with previous PKP had significantly greater endothelial cell loss than eyes with previous DALK or no previous surgery. Preservation of the patient's endothelium seems to be an advantage of DALK in terms of increasing corneal safety in future intraocular surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Comparison of non-contact methods for the measurement of central corneal thickness.

BACKGROUND AND OBJECTIVE: This study examined the repeatability of and agreements between central corneal thickness measurements obtained by four different non-contact pachymetry devices. PATIENTS AND METHODS: Seventy-eight eyes of 39 subjects were included. Central corneal thickness of each eye was measured by Visante optical coherence tomography (OCT) (Carl Zeiss Meditec Inc., Dublin, CA), Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany), Orbscan IIz topography (Bausch & Lomb Surgical Inc., San Dimas, CA), and slit-lamp OCT (SL-OCT) (Heidelberg Engineering GmbH, Heidelberg, Germany). Inter-device agreements and correlations and repeatability of each device were examined. RESULTS: All measurement methods correlated well with each other with a correlation coefficient greater than 0.90 and P value of less than .001 for all comparisons. However, Pentacam overestimated central corneal thickness: 546.7 ± 38.2, 535.5 ± 42.7, 531.7 ± 37.6, and 531.2 ± 36.0 µm for Pentacam, Orbscan IIz, Visante OCT, and SL-OCT, respectively (P < .001 for all comparisons versus Pentacam). Despite good correlation, magnitude of differences was high and this bias was proportional (ie, not constant across a range of corneal thickness values) for the following pairs: Orbscan versus Visante OCT, Orbscan versus SL-OCT, and Orbscan versus Pentacam (P < .001 for all comparisons). CONCLUSION: Although measurements obtained by various non-contact methods correlate well, numerical agreement of the results may not be sufficient for their interchangeable use in clinical practice.

Corneal biomechanical properties of patients with pseudoexfoliation syndrome.

PURPOSE: To assess the corneal biomechanical properties of patients with pseudoexfoliation syndrome (PEX syndrome). METHODS: Fifty-two eyes of 52 patients (27 unilateral and 25 bilateral) and 42 eyes of 42 age-matched control subjects were enrolled in the study. Metrics of corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with the ocular response analyzer (ORA). The ORA also determined the values of Goldmann-correlated intraocular pressure and corneal-compensated intraocular pressure. Central corneal thickness (CCT) was measured by the ORA integrated handheld ultrasonic pachymeter. The values recorded by the ORA were compared between eyes with PEX syndrome and those without PEX syndrome. Eyes with unilateral PEX syndrome and fellow eyes without PEX syndrome were also compared. RESULTS: The mean CH and CRF of all eyes with PEX syndrome were significantly lower than those of control eyes (P < 0.05). Neither corneal-compensated intraocular pressure nor Goldmann-correlated intraocular pressure showed a statistically significant difference in both the groups. Mean CCT values also did not show significant difference. Comparison of the unilateral eyes with PEX syndrome with the apparently normal fellow eyes revealed no significant difference between the mean CCT, mean CH, and mean CRF values (P > 0.05). However, the mean corneal-compensated intraocular pressure and Goldmann-correlated intraocular pressure were relatively higher in the PEX syndrome eye (P < 0.05). There was no significant difference between the mean CCT values of these groups (P > 0.05). CONCLUSIONS: The CH and CRF decrease in both unilateral and bilateral PEX syndrome suggested that PEX syndrome has a weakening effect on corneal biomechanical properties. Moreover, in subjects with clinically unilateral PEX syndrome, these properties were closer to eyes with PEX syndrome than to normal control eyes.